肺内小结节的术前定位在胸腔镜外科手术中的应用价值_俞杞泉.docxVIP

·258·Surgical Research and New Technique Vol. 3 No. 4 December，2014肺内小结节的术前定位在胸腔镜外科手术中的应用价值俞杞泉，王邵华，黄达宇，张慧君，方玉超，许 东，陈晓峰复旦大学附属华山医院北院胸心外科，上海 201907[摘要] 目的 探讨肺内小结节电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）术前采用CT 引导Hook-wire 或亚甲蓝定位的临床价值。方法 90 例肺内小结节手术患者共94 枚小结节，VATS 术前均行CT 引导Hook-wire 或亚甲蓝定位。评价术前定位的成功率、并发症、转开胸手术发生率、术后病理类型等。结果 Hook-wire 钢丝定位72 枚，成功率91.7%；亚甲蓝注射定位22 枚，成功率86.4%。穿刺后发现并发少量血胸6 例（6.4%），并 发少量气胸8 例（8.5%）。转开胸手术4 例，占4.4%。术后经病理证实良性病灶36 枚，占38.3%，恶性病灶58 枚，占 61.7%。结论 术前CT 引导下Hook-wire 或亚甲蓝定位肺内小结节方法准确率高，并发症少，能提高VATS 手术成功率，对肺内小结节的胸腔镜手术诊治具有很好的临床价值。 [关键词] 肺结节；术前定位；电视胸腔镜手术[中图分类号]R734. 2[文献标志码]A[文章编号]2095-378X（2014）04-0258-03Value of preoperative localization of small pulmonary nodules in thoracoscopic surgeryYU Qiquan，WANG Shaohua，HUANG Dayu，ZHANG Huijun，FANG Yuchao，XU Dong，CHEN XiaofengDepartment of Thoracic Surgery，Northern Huashan Hospital，Fudan University，Shanghai 200040，China[Abstact] Objective To analyze the clinical value of preoperative CT- guided Hook-wire puncturing or methylxanthine chloride staining in treatment of the small pulmonary nodules with video assistant thoracic surgery (VATS). Methods A retrospective review of 90 patients with 94 small pulmonary nodules undergoing VATS，using pre-operative CT-guided puncturing or methylxanthine chloride staining was performed. The puncturing achievement ratio， the complications and the conversion to thoracotomy ratio of preoperative localization were summarized and analyzed. Results The puncturing achievement ratio was 91.7% by Hook- wire puncturing and 86.4% by methylxanthine chloride staining，respectively. The complications included pneumothorax，hemothorax，puncturing failure，and Hookwire needle loss. In pathological results，benign lesions and malignant lesions accounted for 38.3% and 61.7% ，respectively. Conclusions The application of preoperative CT- guided Hook- wire puncturing or methylxanthine chloride staining in treatment of the small pulmonary nodules with video assistant thoracic surgery increases the